Chronic Scapular Pain Following Thoracolumbar Adult Spinal Deformity Correction Results in Increased Disability. (16th November 2020)

• Record Type: Journal Article
• Authors: Haddad, Alexander F; Scheer, Justin K; Fury, Marissa; Smith, Justin S; Deviren, Vedat; Ames, Christopher P
• Is Part Of: Neurosurgery. Volume 67(2010)Supplement 1
• Publication Date: 2020-11-16
• Subjects: Nervous system -- Surgery -- Periodicals; 617.48005
• DOI: 10.1093/neuros/nyaa447_724
• Languages: English
• ISSNs: 0148-396X

Abstract

Abstract: INTRODUCTION: Extension of the posterior upper-most instrumented vertebra (UIV) into the upper thoracic (UT) spine allows for a higher degree of spinal alignment correction and reduced incidence of proximal junction kyphosis (PJK) in adult spinal deformity (ASD) patients. Our clinical experience suggests that constructs extending into the UT-spine may be associated with chronic post-operative scapular pain (POSP). However, there is a paucity of literature on the topic. METHODS: ASD patients who underwent multilevel posterior fusion were retrospectively identified and administered a standard survey regarding scapular pain, as well as the Oswestry Disability Index (ODI), by telephone. Respondent medical records were retrospectively reviewed. UT levels were defined as T1-6 and lower thoracic (LT) as T7-12. POSP was defined as pain not present prior to surgery or that was significantly changed from preoperative pain. Univariate and multivariate analysis were used to identify variables associated with the development of POSP and ODI score. RESULTS: A total of 74 ASD patients were included in the study: 37 patients with chronic POSP and 37 without POSP. The mean age was 70.5 years, and 63.9% of patients were female. There was no significant difference in age, sex, history of prior spine surgery, comorbid mechanical complications (PJK, pseudarthrosis, and rod fracture), or reoperation between the groups. Patients with chronic POSP were more likely to have a UT UIV (34/37(91.9%)vs.26/37(74.3%) P = .018). Only 3/14(21.42%) of patients with an LT UIV developed POSP vs. 34/60(56.67%) of patients with a UT UIV. UT UIV was independently associated with POSP on multivariate analysis (OR = 4.99, CI:1.26-19.76, P = .022). ODI score was also significantly higher in patients with POSP (41.20%vs.25.41%, P = .001). POSP (ß = 15.24%, CI:6.16-24.31, P = .001) and prior spine surgery (ß = 9.68%, CI:0.58-16.78, P = .037) were independently associated with ODI on multivariate analysis. We also report patient descriptions of chronic POSP and attempted treatments. CONCLUSION: UT UIV is independently associated with increased odds of chronic POSP which is subsequently associated with significant increases in patient disability. Further investigation into chronic POSP following instrumentation with a UT UIV and preventative or treatment methods is required.